DISEASE
Message of common value
because of abnormal vitreous detachment
A FRES MACULAR HOLE IS SURROUNDED BY A BORDER OF LIQUID ("OEDEMA")
PROBLEM: A MACULAR HOLE GIVES A CENTRAL DEFORMATION AND A CENTRAL BLIND SPOT
THE CAUSE: TRACTION OF THE VITREOUS ON THE CENTRAL RETINA
THE VITREOUS TRACTION MAKES A HOLE IN THE CENTER OF THE RETINA
WITH THE INJECTION OF A DYE (" FLUORESCENCE ANGIOGRAPHY") THE LITTLE HOLE IN THE CENTRAL RETINA IS DETECTED MORE EASILY
AN OCT IS THE BEST WAY TO DETECT A MACULAR HOLE
OPERATION FOR MACULAR HOLE: VITRECTOMIE WITH INTRODUCTION OF TEMPORARY GAZ OR SILICONE OIL
AFTER THE OPERATION: THE PATIENT MUST LOOK DOWN TO MAKE THAT GAZ BUBLLE CLOSES THE MACULAR HOLE (FOR 3 DAYS)
MACULAR HOLE
CAUSE: VITREOUS DETACHEMENT
This is a trivial age-related phenomenon, which consists of the progressive shrinking of the vitreous, so that the structure suddenly (from one day to another) separates from the retina (the membrane that lined the inside of the eyeball). By myopia, where the eye is longer than normal, this happens faster than the others. Sometimes a punch in the eye could be the precipitating cause.
Usually this is symptom-free. Exceptionally, the bond pull a tear in the retina (with swelling of the board: "oedema"). If this happens in the central part of the eye, than we speak of a macular hole.
SIGNS
SYMPTOMS OF MACULAR HOLE: the hole usually gives some blurred vision and some distortion. Progressively worse sight.
SYMPTOMS OF VITREOUS DETACHEMENT
Many people are worried when they see suddenly a few spots in their visual perception, the spots apparently are flying in the air, floating and who move with the movements of the eye ("flying flies"/ "soapbubbles" / "wires") . They are best visible on bright backgrounds (white pages, ceiling, snow), but they disappear in the darkness. These spots are caused by disturbing vitreous bodies (= former bonds at the level of the retina), which are quite central in the perception.
The former bonds sometimes hang onto the retina so that traction on the retina (fortunately usually temporary), which leads to typical flash symptoms. After some time, therefore a hole on the side of the retina occur. These holes can then lead to a retinal detachment. A central hole doesn't.
THE CONSECUENCES
THE EFFECTS OF MACULAR HOLE: the distortion is best followed on an Amsler grid and with OCT. The other eye has a 10% chance of 30 macular hole.
THE EFFECTS OF A VITREOUS DETACHEMENT: Exceptionally vitreous detachment can occur by other phenomena (possibly late):
MINOR BLEEDING (major by anticoagulant!) or RETINA CRACKS can occur, what can lead to a retinal detachment. This, by far can not be demonstrated.
An inspection after one month is sometimes planned, to exclude developed retinal tears with certainty. Who may possibly be treated with laser (virtually painless, no recording required) to prevent a retinal detachment would occur.
The latter could possibly be surgically repaired.
If the BLACK SPOTS and flashes would SIGNIFICANT INCREASE, a consultation must be requested. This must be done if you would expierence a curtain for the eyes.
Anti-inflammatory eye drops may be prescribed in the hope that the resorption of the bonds can be obtained (although this is not a panacea). More that you have to hope that the old bonds become more transparent by gravity sedimentation or digestion.
This usually takes several months. The sagging can not happen if those ties still hang. Thus it is stated that after many years some people still see those spots. If you see flashing lights, try to avoid sudden movements TIP: The less you notice the spots, the less load!
THE TREATMENT
Since a few years the macular hole is carry out with a vitrectomy with peeling out of the cord that pulls on the macula, unless the injury would be more than 9 months.
After vitrectomy, they fill out the eye with SF6 gas, so that the bubble would push against the hole .
To press the gas bubble against the central part of retina, the patient must lay approximately 3 days with his face toward the bottom (3 / 4 hour of every hour), what is difficult, but usually sufficient for closing 95% of the holes.
Some centers may therefore choose for insertion of silicone oil (especially in less co-operative patients), which has the advantage that the patient should not assume that abnormal position.
The silicone oil itself do not disappear, like the SF6 gas, so that after two months or so a second operation is needed to remove the oil.
Vitrectomy and the gas- or silicone bell does decrease the ring oedema, usually with a clear vision improvement as result.
This may take 6 months to complete.
A VITAMIN THERAPY with Nutrof, Preservision or Lutom can contribute (to make pigments such as lutein and zeaxanthin)!
Vision improvement can not be guaranteed and comes only in 50% of cases! Regularly, there is still some distortion.
The main objective is avoiding further progression of the macular hole (with further deterioration of vision as result). There is a small risk of retinal detachment as complication of the surgery!
For possible vitrectomy is usually chosen for general anestesie (given the meticulous manipulations), although a good co-operative patient-anesthesia injection also can be helped.
Anti-coagulants such as aspirin, or asaflow Marcoumar must always be stopped. Best is also the first cataract surgery because the lens is fast becoming cloudy after a vitrectomy.
Moreover, a cataract surgery after vitrectomy is very difficult: there is no back pressure through the vitreous, which makes that the lens drops very deep in the eye, so the manipulations are much deeper than normally would be done.
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